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Permit CITY TIGARD PLUMBING PERMIT fi I� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00074 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/3/2005 SITE ADDRESS: 12635 SW BEEF BEND RD PARCEL: 2S109DD -00100 SUBDIVISION: ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 200 ft DISHWASHERS: RAIN DRAIN: ft Remarks: 200ft. water service. Owner: FEES RIVERSIDE HOMES Description Date Amount 15455 NW GREENBRIER PKWY #140 BEAVERTON, OR 97006 [PLUMB] Permit Fee 3/3/2005 $101.40 [TAX] 8% State Surcharl 3/3/2005 $8.11 Phone : 645 - 0986 Total $109.51 Contractor: RAYBORN'S PLUMBING INC PO BOX 69 REQUIRED ITEMS AND REPORTS TUALATIN, OR 97062 Phone : 503- 692 -4139 Reg #: LIC 87852 PLM 34 -166PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct quest to OUNC by calling (503) 246 -6699. Issued By: ��_ Permittee Signature: f _ /t Call (503) 639 -4175 by 7:00 P.M. for an inspection the next business • ay. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • 'ECE' ED . Plumbing Permit Applicatio> n fic � FOR OFFICE USE ONLY y��i( v v c City of Tigard 1 TIGARD Dat /By: 3/0/0 5 ‘66 Permit No� / © 13125 SW Hall Blvd., Tigard, OR GA OF � � 1 7 Plan Review Phone: 503.639.4171 Fax: 503Av I NG DIVISIO /a , ± Date /By: Other Permit No.: 24- Hour Inspection Line: 503.631744175" C! Date Ready /By: Juris. ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information E ;�* a -�' `�:,- ' :i?;`'. � , m :.. ,\ ° �;�„ ,,.r e ,� :, -£.: , ..- ` *' <� � F� , �. °�:,- � I: ?tea': ..,. -,,: „.,...:.. - . �, �° aTYPE OF W.ORIC ., , � � "��:."r.�,,E�� �<i:,:. .,�.• � .EE SCHEDULE _Z;�•...�. _<, -.��. d'.,, ...,�, > a.. a q::.v.;�< . -..... . >.. ..F•.x�,:.:,. ® New construction ❑ Demolition For special information use checklist Description Qty. Ea. I Total ❑ Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) , ,aTEGORY;OT;; CONSTRUCTION=„ ,, «:t, SFR (1) bath 249.20 ® I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath /kitchen 45.00 ❑ Master builder 2 %,µ.':ms,, °;> ..., Fire sprinkler ( 9 ) g Other• F' sq. ft. Page -, . •r :. , - JOBySITE INral TIOR' ;AND`c'LOC`A °L=ION' Site t'I't' Job site address: 12635 SW Beef Bend Road Catch basin or area drain 16.60 City /State /ZIP: Tigard, Or Drywell, leach line, or trench drain 16.60 Suite /bldg. /apt. no.: Project name: Bella Vista Subdivision Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 1 10.00 Cross street/directions to job sic: Beef Bend Road to New Subdivision - Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Bella Vista I Lot no.: 24 Water service (no. linear ft.: _ Page 2 Page Fixture or item Tax map /parcel no.: valve s A orpt ion `' , DESCRIPTION ,O :.: 4, 4 R 4 ; r !° , ; ,- ,� �,.: ,_., °. ', cv:r., ,,, , ,,, , ,,,, ,,n. ,,,,, ,, � �,,. ., i ° 4 Backflow preventer Page 2 Connect Existing House to New water Main Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 •z�2 ,r Drinking fountain 16.60 , :r u ®" PROPERTY OWNER -- ° < •; l' ; ; ®,. TENANT`m,: -- s ,�-..,., --u" ��.�, ,:, .. Ejectors/sump Name: Riverside Homes Expansion tank 16.60 Address: 1925 NW Amberglen Parkway Fixture /sewer cap 16,60 City /State /ZIP: Beaverton, OR 97006 Floor drain /floor sink/hub 16.60 Phone: (503)645 -0986 Fax: ( ) Garbage disposal 16.60 ;,Q; ,.,:, Hose 16.60 APEI ICANT; s ....• it,4, TAC f,4- / (!,,, < `:. i•' I ma k e r 16.60 Business name: Northwest Earthmovers, Inc. Interceptor /grease trap 16.60 Contact name: Mike Ober Medical gas (value: $ ) Page 2 Address: PO Box 1467 Primer 16.60 City /State /ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60 Phone: (503) 624 -0363 Fax: : (503) 639 - 1634 Sink/basin /lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: mober @nwearthmovers.com Urinal 16.60 - ;: ' y am;, .•, r „,, •�•, 6 , ;1 e , S , I'> :' �,<, . C �`•`a `r i;,Ac� Water closet 16.60 Business name: Rayborn's Plumbing Water heater 16.60 Address: PO Box 69 Other: City /State /ZIP: Tualatin, OR 97062 Subtotal Minimum permit fee: $72.50 / ` l Phone: (503) 692 -4139 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: 87852 Plumbing Lic. no.: 34 -166PB Plan review (25% of permit fee) State surcharge (8% of permit fee) , / X Authorized signature: TOTAL PERMIT FEE / 0q / Print na: J nt % Date: 3j13 Q� This permit application expires if a permit is not obtained within / 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits\PLM- PermitApp doe 12/03 440 -4616T(10 /02 /COM /WEB)